Texas Health Presbyterian Hospital Plano opened in 1991.[/caption]Texas Health Resources said it would continue to provide services regardless of its network status with Blue Cross Blue Shield of Texas, but warned of greater out-of-pocket expenses patients could incur should its contract with BCBS expire at the end of the month.
THR has been trying to extend that contract another 12 months but so far negotiations have not been successful.
The proposed extension would provide additional time to discuss a contract between BCBSTX and Southwestern Health Resources, the integrated health network THR created with UT Southwestern Medical Center to blend the strengths of both health care providers. The partnership, which was announced last October, is an effort to better serve the growing number of residents in North Texas, according to THR.
“We value our relationship with BCBSTX and are hopeful that it will agree to our proposal to extend the current Texas Health contract to give us time to reach agreement on a contract that reflects the integrated approach of Southwestern Health Resources,” according to a THR statement.
Representatives from BCBS said the likelihood of reaching an agreement at this late date is slim, mostly because THR is asking for rate increases BCBS said would negatively impact its members.
"Although we value our relationship with Texas Health, in aggregate, THR is currently the most expensive health care provider in North Texas," BCBS spokesman Chris Callahan said. "Texas Health continues to ask for a rate increase that would cause our members to bear the burden of additional unnecessary and unwarranted costs with no guarantee of better health outcomes. As stewards of our members’ health care coverage dollars, this is unacceptable."
If THR does leave the network, BCBS members in North Texas will still have access to more than 25,000 in-network doctors and 60 in-network hospitals, Callahan said.
As the largest provider of inpatient acute care services and behavior health care in the Dallas Metroplex, area residents with BCBS insurance would have a difficult time accessing some of the basic services they depend upon if THR is outside of network, THR Chief Clinical Officer Daniel Varga said in the statement.
“The North Texas marketplace is a rapidly growing marketplace. It’s also a marketplace that today is experiencing a significant provider shortage,” Varga said. “Having Texas Health Resources and its extensive provider network outside of network means that shortage is only worsened.”
THR’s physicians group sees more than 100,000 patients with Blue Cross insurance each year. The expired contract goes beyond the basic headache of finding a new primary care physician or obstetrician, said Adam Myers, chief medical operations officer for Texas Health Physicians Group.
“We’re worried about potential safety issues,” he said. “Less fluid communication could … put patients in jeopardy. The majority of medical errors result from poor communication between caregivers, according to the Joint Commission. BCBS network members who have to find new physicians and are treated at facilities their doctor’s aren’t familiar with will pot be at more risk for medical errors. We're troubled that Blue Cross would put patients through this.”
